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Review
. 2015 Jul 14;21(26):7954-69.
doi: 10.3748/wjg.v21.i26.7954.

Multimodal treatment of gastric cancer in the west: Where are we going?

Daniele Marrelli  1 , Karol Polom  1 , Giovanni de Manzoni  1 , Paolo Morgagni  1 , Gian Luca Baiocchi  1 , Franco Roviello  1
Affiliations
Review

Multimodal treatment of gastric cancer in the west: Where are we going?

Daniele Marrelli et al. World J Gastroenterol. .

Abstract

The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.

Keywords: Chemotherapy; Epidemiology; Gastric cancer; Hyperthermic intraperitoneal chemotherapy; Radiotherapy; Targeted therapy.

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Figures

Figure 1
Figure 1
Changing number of patients in three subperiods, stratified according to tumor location and Lauren histotype (GIRCG database).
Figure 2
Figure 2
Images of intestinal (A, C) and diffuse type (B, D) tumors of the stomach. The arrow in D indicates the infiltrative growth of the diffuse histotype in the gastric wall.
Figure 3
Figure 3
Incidence of lymph node metastases according to Lauren histotype stratified for pT stages (GIRCG database).
Figure 4
Figure 4
Survival rate of patients with peritoneal recurrence of gastric cancer.
Figure 5
Figure 5
Proposal of a tailored multimodal approach in resectable non-cardiac gastric cancer. JGCA: Japanese Gastric Cancer Association; NAC: Neoadjuvant chemotherapy; HIPEC: Hyperthermic intraperitoneal chemotherapy.
See this image and copyright information in PMC

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